Elévation faible d’hCG en dehors d’un contexte gravidique : à propos de deux cas et revue de la littérature

in Annales de Biologie Clinique (2013), Sous presse

Unexpected finding or persistence of low human chorionic gonadotropin (hCG) levels is not a rare situation. It requires a clinico-biological approach in order to avoid misunderstandings that could lead to ... [more ▼]

Unexpected finding or persistence of low human chorionic gonadotropin (hCG) levels is not a rare situation. It requires a clinico-biological approach in order to avoid misunderstandings that could lead to inappropriate diagnostic or therapeutic attitudes. Outside the context of a pregnancy, persistent low levels of hCG may be associated with various benign and malignant conditions, i.e. quiescent gestational trophoblastic disease (QTD), raised pituitary hCG or false positive elevation caused by circulating heterophile antibodies. We report the cases of two non-pregnant patients with low serum hCG. In the first case, hCG levels raised during several years following a spontaneous abortion. The likelihood of heterophilic antibodies interference was ruled out and extensive clinical investigation excluded the presence of a tumour. The diagnosis was QTD. In the second case, elevated hCG came to light as an incidental finding in a women with chronic renal failure and led the clinicians to question the laboratory. The cause was probably an increase in pituitary hCG consecutive to terminal renal failure. These cases illustrate the importance of understanding the biology of the hCG and the causes of its persistent low elevation, which are reviewed in this article. It is essential to demonstrate clinically the presence of a tumour in order to avoid unnecessary and ineffective chemotherapy and/or hysterectomy. [less ▲]

Contribution of Robotic Surgery to Gynecologic Oncology

Conference (2012, September 14)

Differential expression of Vegfr-2 and its soluble form in preeclampsia.

in PLoS ONE (2012), 7(3), 33475

Background: Several studies have suggested that the main features of preeclampsia (PE) are consequences of endothelial dysfunction related to excess circulating anti-angiogenic factors, most notably ... [more ▼]

Background: Several studies have suggested that the main features of preeclampsia (PE) are consequences of endothelial dysfunction related to excess circulating anti-angiogenic factors, most notably, soluble sVEGFR-1 (also known as sFlt-1) and soluble endoglin (sEng), as well as to decreased PlGF. Recently, soluble VEGF type 2 receptor (sVEGFR-2) has emerged as a crucial regulator of lymphangiogenesis. To date, however, there is a paucity of information on the changes of VEGFR-2 that occur during the clinical onset of PE. Therefore, the aim of our study was to characterize the plasma levels of VEGFR-2 in PE patients and to perform VEGFR-2 immunolocalization in placenta. METHODOLOGY/PRINCIPAL FINDINGS: By ELISA, we observed that the VEGFR-2 plasma levels were reduced during PE compared with normal gestational age matched pregnancies, whereas the VEGFR-1 and Eng plasma levels were increased. The dramatic drop in the VEGFR-1 levels shortly after delivery confirmed its placental origin. In contrast, the plasma levels of Eng and VEGFR-2 decreased only moderately during the early postpartum period. An RT-PCR analysis showed that the relative levels of VEGFR-1, sVEGFR-1 and Eng mRNA were increased in the placentas of women with severe PE. The relative levels of VEGFR-2 mRNA as well as expressing cells, were similar in both groups. We also made the novel finding that a recently described alternatively spliced VEGFR-2 mRNA variant was present at lower relative levels in the preeclamptic placentas. CONCLUSIONS/SIGNIFICANCE: Our results indicate that the plasma levels of anti-angiogenic factors, particularly VEGFR-1 and VEGFR-2, behave in different ways after delivery. The rapid decrease in plasma VEGFR-1 levels appears to be a consequence of the delivery of the placenta. The persistent circulating levels of VEGFR-2 suggest a maternal endothelial origin of this peptide. The decreased VEGFR-2 plasma levels in preeclamptic women may serve as a marker of endothelial dysfunction. [less ▲]

Lymphadénectomie para-aortique par laparoscopie assistée par robot dans le bilan des cancers du col utérin localement avancés. Étude belge multicentrique.

Poster (2012)

The prospective Belgian experience of robot-assisted management of apparent early-stage endometrial cancer : relation between surgical outcomes and obesity.

Poster (2012)

Belgian experience of robot assisted laparoscopic para – aortic lymphadenectomy for staging of locally advanced cervical carcinoma. A multicentric study.

Poster (2012)

Objectives: FIGO clinical staging, imaging techniques sometimes underestimate extension of locally advanced cervical cancer (LACC). The presence of para-aortic lymph node (LN) metastases in LACC ... [more ▼]

Objectives: FIGO clinical staging, imaging techniques sometimes underestimate extension of locally advanced cervical cancer (LACC). The presence of para-aortic lymph node (LN) metastases in LACC identifies patients with poor prognosis. Laparoscopic para-aortic lymphadenectomy is now proposed as a diagnostic tool. Feasibility and safety of robot assisted laparoscopic para-aortic lymphadenectomy has been reported. We collected data from different Belgian centers to assess its oncological safety and complication rate. Study design: Three centers participated in the study. Thirty seven patients with LACC underwent a pre treatment robot assisted laparoscopic para-aortic lymphadenectomy. Data was prospectively collected. Results: The median number of LN collected was 27.5 (1-54) per patient. Five out of 37 patients had para-aortic node metastasis. The false negative rate for PET CT diagnosing para- aortic node metastasis was 10.8% (4/37). We encountered 2 major intra operative complications (5.4%). Post operative morbidity was low (13.5%). Median follow up was 27 months (95% CI 24–30). Median disease free survival (DFS) was 16 months (95% CI 2.4- 29.6). Patients with negative LN had a median DFS of 24 months (NA) although patients with positive LN had a median DFS of 9 months (95% CI 6.9-11.9). Conclusions: In this series we report that robot assisted laparoscopic para-aortic lymphadencetomy provided the surgeon with useful information to avoid understaging in 10.8% of women with LACC, at the expense of low morbidity (13.5%). Presence of microscopic para-aortic LN metastasis is correlated with shorter DFS. The number of patients with positive LN doesn’t allow us to draw any firm conclusion. [less ▲]

From the Clinics to the Bench and back to the Clinics: design of a medical treatment for Cervical Intraepithelial Neoplasia (CIN)

Conference (2011, May 20)

Whole Slide Quantification of Stromal Lymphatic Vessel Distribution and Peritumoral Lymphatic Vessel Density in Early Invasive Cervical Cancer: A Method Description

in ISRN Obstetrics and Gynecology (2011), 2011

Peritumoral Lymphatic Vessel Density (LVD) is considered to be a predictive marker for the presence of lymph node metastases in cervical cancer. However, when LVD quantification relies on conventional ... [more ▼]

Peritumoral Lymphatic Vessel Density (LVD) is considered to be a predictive marker for the presence of lymph node metastases in cervical cancer. However, when LVD quantification relies on conventional optical microscopy and the hot spot technique, interobserver variability is significant and yields inconsistent conclusions. In this work, we describe an original method that applies computed image analysis to whole slide scanned tissue sections following immunohistochemical lymphatic vessel staining. This procedure allows to determine an objective LVD quantification as well as the lymphatic vessel distribution and its heterogeneity within the stroma surrounding the invasive tumor bundles. The proposed technique can be useful to better characterize lymphatic vessel interactions with tumor cells and could potentially impact on prognosis and therapeutic decisions. [less ▲]

Analysis of 13 Million Individual Patient Records Pertaining To Pap Smears, Colposcopies, Biopsies and Surgery on The Uterine Cervix (Belgium, 1996–2000)

in Preventive Medicine (2009)

Objective Cervical cancer screening by surveys overestimate coverage because of selection and reporting biases. Methods The prepared Inter-Mutualistic Agency dataset has about 13 million records from Pap ... [more ▼]

Objective Cervical cancer screening by surveys overestimate coverage because of selection and reporting biases. Methods The prepared Inter-Mutualistic Agency dataset has about 13 million records from Pap smears, colposcopies, cervical biopsies and surgery, performed in Belgium between 1996 and 2000. Cervical cancer screening coverage was defined as the proportion of the target population (women of 25–64 years) that has had a Pap smear taken within the last 3 years. Proportions and incidence rates were computed using official population data of the corresponding age group, area and calendar year. Results Cervical cancer screening coverage, in the period 1998–2000, was 59% at national level, for the target age group 25–64 years. Differences were small between the 3 regions. Variation ranged from 39% to 71%. Coverage was 64% for 25–29 year old women, 67% for those aged 30–39 years, 56% for those aged 50–54. The modal screening interval was 1 year. In the 3-year period 1998–2000, 3 million smears were taken from the 2.7 million women in the age group 25–64. Only 1.6 million women of the target group got one or more smears in that period and 1.1 million women had no smears, corresponding to an average of 1.88 smears per woman. Conclusion Coverage reached only 59%, but the number of smears used was sufficient to cover more than 100% of the target population. Structural reduction of overuse and extension of coverage is warranted. [less ▲]

Le cancer du col de l'utérus: du virus au traitement

in Revue Médicale de Liège (2007), 62(S1)

Squamous cell cancer of the uterine cervix is associated with a high morbidity and mortality worldwide and in Belgium. New therapeutic approaches have been recently proposed. The development of this ... [more ▼]

Squamous cell cancer of the uterine cervix is associated with a high morbidity and mortality worldwide and in Belgium. New therapeutic approaches have been recently proposed. The development of this cancer is related to the infection by oncogenic human papillomavirus (HPV) types. The link between cervical cancer and HPV has, in recent years, generated, a great interest for studies aiming to better understand the role of the immune system in the control of these infections and for the development of prophylactic anti-HPV vaccines. [less ▲]